In the Journals

“Healing holidays?” – a special issue of Anthropology & Medicine on medical tourism

The latest Anthropology & Medicine is a special issue on medical tourism which includes work by anthropologists and historians on various examples of medical travel.  What makes this issue particularly interesting is that it brings together work examining the kind of phenomena that have become exemplary of “medical tourism” in the 21st century — underinsured middle-class Americans traveling to India for surgery — with analyses of the Euro-American tradition of traveling to spas and sanitariums.  In his Afterword, George Weisz discusses this distinction in terms of the different meaning of locality and place in each:

“What is unusual about the newest sort of ‘health tourism’ discussed in several papers in this issue is that technology and excellence are only some of the attracting features. Relatively low costs, desire to avoid waiting lists, access to procedures or facilities unavailable and possibly illegal at home, are often determining factors in individual decisions to travel for health care…..In many ways, ‘tourism’ is a catchy misnomer that simply means traveling long distances for medical care not dissimilar to what is available at home. While this phenomenon has relevance for medical care and global health and for the ways social scientists study them, such practices can best be seen as yet another example of the expanding global economy, another form of ‘offshoring’ goods and services, whose consequences have yet to be fully understood,” (Weisz 2011).

Weisz contrasts such medical tourism with those cases in which “the therapy and the pleasures of tourism are inextricably linked and are intimately associated with specific places considered especially ‘healthy’ and, not inconsequentially, pleasant and attractive: the hilltop stations of colonial India; mountain tuberculosis sanatoria; and among the earliest examples, mineral waters spas,”(Weisz 2011).

In their Introduction, guest editors Harish Naraindas and Cristiana Bastos emphasize the continuities in processes underlying these two types of medical travel:

“It is evident that what makes patients itinerant in both the old and new kind of medical travel is either a perceived shortage or constraint at ‘home’, or the sense of having reached a particular kind of therapeutic impasse, with the two often so intertwined that it is difficult to tell them apart. The constraint may stem from things as diverse as religious injunctions, legal hurdles, social approbation, or seasonal affliction; and the shortage can range from a lack of privacy, of insurance, technology, competence, or enough therapeutic resources that can address issues and conditions that patients have.

While those constraints and shortages may be an amalgam of the legal, social, religious and technological, and may be directly responsible for unresolved health issues, they are also due to a therapeutic impasse resulting from orthodox medicine’s inability to provide a solution for many patients’ problems. If these two intertwined strands are responsible for most medical tourism, then which locales seem to have therapeutic resources are those that are either ‘natural,’ in the form of water or climate; legal, in the form of a culture that does not stigmatise patients; or technological and professional, in the form of tests, equipment, or expertise, unavailable or affordable at home; or in the form of novel therapeutic possibilities that promise to resolve irresolvable issues,” (Naraindas and Bastos 2011).

Here are the titles and abstracts:

Harish Naraindas and Cristiana Bastos, Healing holidays? Itinerant patients, therapeutic locales and the quest for health?

Lauren E. LaFauci, Taking the (southern) waters: science, slavery, and nationalism at the Virginia springs

‘Taking the (southern) waters’ argues that, in the pre-Civil War period, the space of Virginia’s mineral water resorts and the philosophy of southern hydropathic medicine enabled – indeed, fostered – white southerners’ constructions of a ‘nationalist,’ proslavery ideology. In the first half of the paper, the author explains how white southern health-seekers came to view the springs region as a medicinal resource peculiarly designed for the healing of southern diseases and for the restoration of white southern constitutions; in the second half, she shows how physical and social aspects of the resorts, such as architectural choices and political events, supported and encouraged proslavery ideologies. Taken together, these medical-social analyses reveal how elite white southerners in the antebellum period came to associate the health of their peculiarly ‘southern’ bodies with the future health of an independent southern nation, one that elided black bodily presence at the same time that its social structures and scientific apparatuses relied upon enslaved black labor.

Maria Manuel Quintela, ?Seeking ‘energy’ vs. pain relief in spas in Brazil (Caldas da Imperatriz) and Portugal (Termas da Sulfúrea)?

This paper is a comparative ethnography of the therapeutic practices at two different spa locations: Caldas da Imperatriz, SC, Brazil, and Termas da Sulfrea in Cabeo de Vide, Portugal. The comparison reveals the existence of contrasting ‘explanatory models’ held by the spa-goers as well as by the official medical systems. In the Portuguese context this model is highly medicalized; in the Brazilian case, spa treatments are viewed as ‘alternative’ or ‘complementary’ therapy and are also related to religious philosophies. Each model corresponds to a different idiom expressing certain experiences and world views, one focusing on ‘pains’ (dores) and the other on ‘energy’ (energia), the former leading to the rationale of ‘curing’, the latter to the notion of ‘energizing’. In this paper the author intends to analyze and contrast the categories found in these models, which originate from different conceptions of health, illness and healing for Brazilian and Portuguese spa-goers.

Algarve Cristiana Bastos, From sulphur to perfume: spa and SPA at Monchique

In the thermal village of Monchique, Algarve, different streams of water-related knowledge and practices coexisted for centuries. Those waters were traditionally known as guas santas (holy waters) and believed to have redemptive healing powers. In the seventeenth century, the Catholic church took control of the place, refashioned the bathing rituals, developed infrastructures and provided assistance to the patients, granting free treatment to the poor. In the nineteenth century, the state replaced the church and imposed that treatments should be provided by professionals trained in the scientific principles of medical hydrology. Secular and scientific as they were, clinical logbooks still allowed for the account of patients that embodied miracle-like redemptive cures ‘at the third bath’. People went to Monchique both for its magic and its medicine, bringing in the body ailments achieved in their lives of hard labour. They also went there for a socialising break while healing. From mendicants to rich landowners, coming mostly from the Algarve and neighbouring Alentejo, they crowded the place in summertime. In the twentieth century, as in other places in continental Europe, the spa evolved into a highly medicalised place that qualified for medical expenses reimbursements, which implied the eclipsing – at least from representation – of its leisure component. In the twenty-first century, a new trend of consumer-centred, market-based, post-water balneology with an emphasis on wellness and leisure reinvented the spa as place for lush and diversified consumption. This article argues that the seemingly contradictory systems (markets and medicine) coexist much in the same way that magic, religion and medicine coexisted in the old water sites. The new SPAs, rather than putting an end to the old spas, have enabled them to survive by reinventing thermal sites as places of attraction and leisure.

Amy R. Speier, Health tourism in a Czech health spa

This paper is about the changing shape of health tourism in a Czech spa town. The research focuses on balneotherapy as a traditional Czech healing technique, which involves complex drinking and bathing therapies, as it is increasingly being incorporated into the development of a Czech health tourism industry. Today, the health tourism industry in Marinsk Lzn is attempting to ‘harmoniously’ combine three elements – balneology, travel and business activities. One detects subtle shifts and consequent incongruities as doctors struggle for control over the medical portion of spa hotels. At the same time, marketing groups are creating new packages for a general clientele, and the implementation of these new packages de-medicalizes balneotherapy. Related to the issue of the doctor’s authority in the spa, the changes occurring with the privatization of tourism entails the entrance of ‘tourists’ to Marinsk Lzn who are not necessarily seeking spa treatment but who are still staying at spa hotels. There is a general consensus among spa doctors and employees that balneotherapy has become commodified. Thus, while balneotherapy remains a traditional form of therapy, the commercial context in which it exists has created a new form of health tourism.

Harish Naraindas, Of relics, body parts and laser beams: the German Heilpraktiker and his Ayurvedic spa ?

This paper examines the twin German institutions of the Kur (spa), and the ‘lay’ licensed healing practitioner or Heilpraktiker. Through an ethnography of a Heilpraktiker and his Ayurvedic spa in a small catholic village in Germany, where patients arrive in person or as body parts by post, it examines the poly-therapeutics of the practitioner, who seems to combine in his being a dizzy array of diagnostic and therapeutic possibilities. It argues that the while the Ayurvedic spa can be seen as a kind of variation of the traditional German Kur, the Heilpraktiker’s poly-therapy has to draw upon the special nature of the practice of medicine in Germany, symbolised in part by the very figure of the Heilpraktiker. It attempts to show that the practitioner’s panoply of therapies is partly a symptom of an epistemic impasse at the heart of biomedicine, leading patients on an itinerant quest toward different therapeutic locales, such as the Kur, or to different therapeutic possibilities, such as the ones offered by the Heilpraktiker. But while the Kur and the Heilpraktiker would be either fringe or alternative in the Anglo-American world, in Germany the Kur is part of orthodox medicine, and the Heilpraktiker is a legal entity; and the two together re-draw and make fuzzy what elsewhere seem to be clearly drawn boundaries between medicine and the spa, between pleasure and therapy, and medicine and alternative medicine.

Marcia C. Inhorn, Globalization and gametes: reproductive ‘tourism,’ Islamic bioethics, and Middle Eastern modernity ?

‘Reproductive tourism’ has been defined as the search for assisted reproductive technologies (ARTs) and human gametes (eggs, sperm, embryos) across national and international borders. This article conceptualizes reproductive tourism within ‘global reproscapes,’ which involve the circulation of actors, technologies, money, media, ideas, and human gametes, all moving in complicated manners across geographical landscapes. Focusing on the Muslim countries of the Middle East, the article explores the Islamic ‘local moral worlds’ informing the movements of Middle Eastern infertile couples. The ban on third-party gamete donation in Sunni Muslim-majority countries and the recent allowance of donor technologies in the Shia Muslim-majority countries of Iran and Lebanon have led to significant movements of infertile couples across Middle Eastern national borders. In the new millennium, Iran is leading the way into this ‘brave new world’ of high-tech, third-party assisted conception, with Islamic bioethical discourses being used to justify various forms of technological assistance. Although the Middle East is rarely regarded in this way, it is a key site for understanding the intersection of technoscience, religious morality, and modernity, all of which are deeply implicated in the new world of reproductive tourism.

Harris Solomon, Affective journeys: the emotional structuring of medical tourism in India ?

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel’s ability to ease the linked somatic, emotional, financial, and political injuries of being ill ‘back home’. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India’s popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India.

Elisa J. Sobo, Elizabeth Herlihy and Mary Bicker, Selling medical travel to US patient-consumers: the cultural appeal of website marketing messages

More US-based patients than ever are travelling abroad for medical or dental services. Beyond financial incentives, what cultural factors have supported this trend? Because of their interest in selling medical travel, medical travel agencies (MTAs) have vested interests in this question. To find out how they are answering it, an ethnographic content analysis of MTA websites was undertaken. Beyond themes promoting a ‘worry-free experience’ of ‘legitimate services’, themes linking healthcare consumerism to culturally specific identity ideals and self-creation/representation processes predominated. Themes relating to the demonstration of social position, savvy expression of good consumer judgment, and achievement of libertarian ideals figured highly. However, various inconsistencies (including an appeal to tourism in some but not other situations) suggested that medical travel involves, for the US-based consumer, a complex act of juggling context-specific self-identity desires and expectations in relation to healthcare. The potential impact of prevailing discourses on ‘self-construction-in-practice’ was explored. Findings enhance understanding of the care seeking process as experienced within the context of globalized, mass-mediated healthcare consumerism. They also point to the need for finer-grained distinctions than the global gloss ‘medical travel’ offers.

George Weisz, Afterword:? Historical reflections on medical travel ?

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